A Diagnostic Conundrum: Unusual Presentation of Acute Cutaneous Lupus Erythematosus Mimicking Toxic Epidermal Necrolysis

Systemic lupus erythematosus (SLE) is an intricate autoimmune disorder with diverse clinical presentations, encompassing various cutaneous manifestations. This case report describes a diagnostically challenging occurrence of acute cutaneous lupus erythematosus (ACLE) exhibiting a toxic epidermal necrolysis (TEN)-like rash in a 28-year-old female already diagnosed with SLE. The patient's rapid progression from itching to maculopapular skin eruptions involving the face, extremities, and torso within days, coupled with facial puffiness and systemic symptoms, presented a clinical conundrum. Histopathological findings of epidermal hyperkeratosis, acanthosis, and a subcorneal neutrophilic abscess guided the exclusion of other conditions, emphasizing the distinctive features of TEN-like ACLE. The patient exhibited a favorable response to pulse methylprednisolone, mycophenolate mofetil, and hydroxychloroquine.